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Case 70763

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Troublesome / painful / cracked tooth (Endodontic)

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Canaray 70763

1. Benign neoplasm in left maxilla

A well-defined radiolucency is present in the left maxilla, which extends through the alveolar process between teeth 21 and 26. This entity extends into the left nasal cavity to the level of the middle meatus, and the normal nasal architecture is effaced in this region. The internal aspect of this entity appears to be radiolucent, and the residual cortex is faint and exhibits a granular appearance. The maxillary sinus floor is elevated, and the residual posterosuperior air space is opacified due to impaired antral drainage. The palatal cortical plate is expanded, thinned, and partially dehiscent. Focal areas of buccal cortical dehiscence are also evident. No significant root displacement or resorption is evident. This radiographic appearance is most consistent with a benign neoplasm. The granular nature of the residual cortex suggests the possibility of a poorly mineralized ossifying fibroma. Biopsy and histopathologic assessment is indicated.

Axial views of maxilla

These axial cross-sectional images demonstrate the extension of the radiolucent entity in the left maxilla between teeth 21 and 26. Extension of this entity into the left nasal cavity is also evident. The thinned and expanded palatal cortex is granular in nature.

Coronal views of maxilla

These coronal cross-sectional images demonstrate effacement of the inferior nasal meatus and concha due to extension of the benign neoplasm into this area. Although the residual sinus floor is only elevated to the level of the middle nasal meatus, the residual superior and posterior antral air space is opacified. This reflects obstruction of the osteomeatal unit.

Sagittal views of left maxilla

These sagittal cross-sectional images demonstrate the faint cortex apical to tooth 26, which reflects the posterior extent of the area of pathology in the left maxilla. The remaining antral cavity is opacified due to secondarily retained secretions. This should not be interpreted as pathology occupying the entire left maxillary sinus. Biopsy access through the buccal cortex of the maxilla between the apices of teeth 21 and 26 is indicated.

2. Ethmoid sinusitis

The ethmoid air cells are nearly completely opacified, an appearance consistent with sinusitis.

3. Mucositis of the sphenoid sinus

Mild mucositis is present in the left loculation of the sphenoid sinus. This is an incidental finding with no clinical significance.

4. Monckeberg's arteriosclerosis

Calcifications are visible in the tunica media of the parasellar segments of the internal carotid arteries. This is an incidental finding with no proven clinical significance and is suggestive of the presence of Monckeberg's arteriosclerosis.

5. Calcified stylohyoid ligaments

The stylohyoid ligaments are partially calcified bilaterally. This is an incidental finding with no clinical significance.

6. Left palatine tonsilloliths

Tonsilloliths are present in the left palatine tonsil. This is an incidental finding with no clinical significance.